Steroid Shots: Benefits & Risks

Corticosteroid injections are used to treat a number of musculoskeletal conditions, such as tendinitis, osteo­­arthritis, bursitis and carpal tunnel syndrome. Certain kinds of chronic neck or low back pain are also treated with steroid injections when more conservative treatments, such as pain relievers and physical therapy, don’t help enough. Steroids are thought to work primarily by relieving inflammation.

Steroid shots: evaluating the benefits . . .

Studies have tended to be of poor quality and have yielded mixed results, making it hard to say when or how steroid injections are best used. Overall, though, there is evidence of at least short-term bene­fit for certain conditions.

. . . and the risks

Adverse effects from steroid injections are generally uncommon and, when they do occur, are usually mild and temporary. Local reactions include pain, redness and swelling. Some skin atrophy and pigment changes, mostly a cosmetic issue, are possible. Certain injections may weaken tendons and other connective tissue, which can cause ruptures, though this is relatively rare. And some people experience post-injection “flares,” a temporary worsening of symptoms of the condition being treated.

The most common systemic effect is a short-term impairment in blood sugar regulation—which is why people with diabetes are told to monitor their blood sugar more closely for the first few days.

Another concern: Steroid injections may increase bone loss. A small study published in Spine in 2012 found that postmenopausal women who received an epidural steroid injection had a decline in bone density of the hip six months later, more than other women their age. And last year a large study published in the Journal of Bone and Joint Surgery found a modestly increased risk of vertebral fractures in older women who had epidural injections, compared to those who had other treatments, with the risk increasing with each injection.

Words to the wise

If you are considering a steroid injection, your doctor should discuss the benefits and risks with you, taking into account your medical history, risk factors for diseases such as osteoporosis, and drugs you are taking. It’s important to go to an experienced practi­tioner, since some shots are tricky to give, and some sites are more prone to injury.

In some cases, such as for back pain, steroid injections should not be the first line of therapy; they tend to be overused in general for back pain in the U.S. But in other cases—such as trigger finger (stenosing tenosynovitis), certain types of bursitis and rotator cuff inflammation—they may be all that’s needed. How often the injections should be given varies, depending on the circumstances. In general, the fewer the shots, the lower the risk for adverse effects. For many chronic or recurrent conditions, a reasonable guideline is no more than one shot every four to six months.

Steroid injections made headlines in 2012 when hundreds of people developed fungal meningitis and spinal infections from a contaminated batch and some died. The illnesses were traced back to a compounding pharmacy.